Ten Fallacies and Ten Truths of Psychopharmacology—Explained

Ten fallacies and ten truths in the practice of psychopharmacology are provided and explained. The fallacies are: More is better; What gets you well keeps you well; Treat to remission; Polypharmacy is good; Make one change at a time; 4–8 weeks is a sufficient trial of a drug; Dose low, go slow; Always taper a drug; Treat the most severe symptom; and Always incorporate the patient’s preference. The ten truths are: Your treatment is as good as your diagnosis; Treat diseases, not symptoms; All drugs are guilty until proven innocent; All drugs are toxic, dosing and indication make them therapeutic; Always have an exit strategy; Most current psychotropic drugs have some dramatic benefits but are not disease-modifying—the clearest exception is lithium; Older drugs are more effective than newer drugs; Newer drugs are more tolerable older drugs; Treatment “resistance” usually reflects either misdiagnosis or an invalid diagnosis; and Course, not symptoms, reveals the diagnosis These examples highlight common issues or debates in clinical psychopharmacology, and provide a perspective that promotes the Hippocratic, disease-oriented, clinically based approach of this text.